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tv   Federation of American Hospitals Policy Conference  CSPAN  March 8, 2014 10:00am-11:10am EST

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at the federation of american hospitals talking about health care choices facing america. all loads by mitch and other speakers from the political action conference. then let coverage of the last day of this year's see pack -- cpac conference with newt gingrich. senate finance committee ron wyden spoke tuesday about health choices facing the united states. he spoke at a conference hosted by the federation of american hospitals. the chairman and president also spoke eared this is about one hour. -- spoke. this is about one hour. [applause] good morning. it is hard to follow ray charles. if that does not bring a chill down your back, nothing will. i and the president of the art
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and help services the newly elected chairman of the federation for 2014. i think it is only appropriate that everyone take their phone device, hold it up, and take a photo of yourself. anybody that was start a meeting before 8:00 on eastern time zone cannot be all there. of yousuming that most have had the opportunity to get at least your first cup of $10 starbuck coffee down your belly in you're starting to feel good. good morning. i want to acknowledge someone before you yesterday. this is for 2013. the passion for this organization and for our industry has been incredible and has been part of what this
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organization is all about. the type of person that he is on the has been, and will continue to be. the energy and effort that he put in this job is a guiding light for those of us who are going to have to follow him and all the things that he did. if you will stand up, everyone is him a round of applause. [applause] jim henson. he is the chairman of the american hospital association and president and ceo of presbyterian health services in new mexico. he was supposed to be here with us. unfortunately, the weather eliminated his ability to make it here. the reason he was going to be
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here is jim and i are fierce competitors in new mexico. it just happened to be that he had been the chairman of the hospital association and me the federation, we thought we would have a good time today talking to you and banter a little bit. he cannot make it. we will have to do that another time where we can share the stage together. we are still going to have an especially valuable time for all of us. as we hear directly from the political and policy leaders who will shape and impact our industry in the months and years to come. from the comments i have heard yesterday, this meeting has arty been a success for many of you. i heard a lot if you talk about general hayden and a lot of us have the same feeling, you would like to get a big bottle of scotch and sit down with the guy for about two hours and find out
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what he really knows. [applause] i also -- likewise, i heard about the buyers exposition and i had an opportunity to walk through the halls yesterday. admittedly, i walked through the halls at lunch and none of you were there. it was good meeting you. [laughter] thank you for your role in the success of this exposition. a special thanks to our sponsors. other names are going to be rolling across the screen. hopefully you will take the opportunity to of the knowledge who they are. i have been to this event or about 25 years. it seems odd this year that we come. i can remember when the cherry blossoms were blooming. admittedly, we may have been coming a little later. it is a stark difference in regard to what is going on today if you go outside of and it is about 16 degrees outside versus
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when there is so much pollen in the air you could hardly breathe. you think about the transition between where we are going in the winter and trying to get to spring, we continue to be in transition. we are not the only industry. going through transition. whether it is the banking opposite.r quite the maybe the video industry. how many of you out there today think three years or five years ago had a card in your pocket that was lou piniella and it was a blockbuster card. how many of you have those cards? how many of you still have those cards? they're taking up space if you still have one today. blockbuster was a dominant leader in that industry.
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it was capital intensive. it had a lot of employees. the netflix comes up. they had a business model that was a little bit different. they did a mail order disk. less capital. large distribution -- large just region centers. streamingx introduced video. last week netflix announces their big deal with comcast so they can get directly to the cable customer delivering even faster streaming speeds. during the evening hours now, and that flex u.s. subscribers generate ready percent of the downloading activity on the internet.
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between 9:00 and 11:00 p.m., 30% of the activity is going through netflix are using a netflix video. to increasected with the comcast transaction. was a simple, disruptive transition, one business model going to another. us, and our industry, whether it is the affordable care act or all the other things going on, there is a great deal of uncertainty. we begin our own brought on byio opposition in a much more powerful customer. as we all know, all the best ideas come from washington, d.c. if you do not believe me, just ask them. they createdngton
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something called the tube and night role -- two men night ru le. i want to apply that to the marriott. i do not think they will like it but you will. if you are a customer of marriott, as long as you do not stay were the eight hours on the think about this, you state 47 state 47 hours, they will feed you six meals a man when you walk out today i want you to tell them i want to ruleise my to midnight discount. of what the 1/3 bill is. int is what happens to us the hospital with the latest great idea and washington, d.c. they say about 48 hours or little bit less.
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we get all the same costs only pay one third of what we used to. that is not right. that is what is happening to our hospitals. for those of you in this room that our suppliers and vendors and partners of our hospitals, the more money they take from us the less money we are going to have to spend with you. to educate and advise politicians and policy leaders on regulations that just and fundingsense decisions that plays hospitals in jeopardy, we need to build relationships with new partners. and strengthen our connections with the groups or individuals that already share ideas for this industry. your activee
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involvement is needed and required. we must caution our elected officials and their actions on how continual cuts for services ,e deliver is not a solution articular leak at the cuts are simply coming so congress can pay for another great idea. that medicare is the piggy bank for every other program that lacks funding is not a solution. to industry was asked provide better services to medicare customers. our industry was asked to improve our quality. if you look at our core measures, our readmission rates, everything is improved. we did what they asked. ourere asked to improve
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efficiencies. if you look at our facilities and operations today, we did what they asked. we were asked to take cuts to help fund the affordable care act. we did that as well. time to write or visit your congressional representative and let them know their actions have consequences. consequences to our industry can be devastating if done the wrong way. access the you to federation blog which was up right now and twitter accounts. if you need information as it relates to providing your congressional leaders with information about what their actions are doing to our industry, i would encourage you to check our blog and twitter out. people will get back to you and provide information necessary
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that we can educate those individuals that are adversely impacting us today. rest going to have a great of the day. i would like to introduce the president and ceo of the federation. jim? [applause] >> thank you. that was great. a good way to start off the morning. good morning to everyone in the audience. thank you for coming. ister widen -- senator wyden on the way. i will also remind you follow us edamerhospital twitter or at my @chipkahn.
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congressman ryan was cut in the weather. one of our casualties. he is in a plane right now. we're going to miss him. he has promised that he will, next year. i am sure all of you will be here next year and we will have congressman ryan for you. we have senator blunt. administrator and senator to meet you will be up this morning. program, iet to the want to make an announcement that is unique to this program. it provides an opportunity. today we can put -- today, if we budget up the slides, is day in washington. it is the day that the white house releases the president's budget for fiscal year 2015. the federation is releasing a
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new report on this day on national spending trend in health care and it's publications for medicare policy and the federal budget. this was prepared by health economist out datsun. it updates a previous report he did for us in june 2013. he examines of the forces ofving the historic trends health care growth and developed estimates of potential additional savings in medicare if the current trends continue. there are new empirical studies in cms data. all these are documented in the report. taken together, this gives us
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even greater confidence that the forces transforming health care finance and delivery are structural and systematic. thisally, some suggested was fueled by cyclical economic activity german by the great depression. -- recession. i and some -- i am sure some thought it was a depression. it suggest the economy may have had an even smaller impact on health care spending than earlier felt. the report we will release shows that sustained slowdown is an herbal and that additional savings are more likely to materialize even as the economy continues its recovery. let's go to the numbers. the punchline.th $900 billion in additional medicare savings is within reach if we stay the course. what do i mean? what does it show?
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medicare spending has slowed beyond anyone's expectations and has remain low for several years. the cbo to lower the annual 10 year forecast of program spending for the six consecutive year. forecastrecent budget issued last month lowered medicare spending by another $154 billion the on it previous forecast. it issued just nine months ago. you may know that several years ago i was stopped or her of the house ways and means subcommittee. it was my job to follow and adhere to the cbo, cost estimates, budget report, every issue. it is what congress relies on.
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rate from 2010-2013. rate to theied that most recent cbo baseline in medicare spending. his conclusion? medicare spending over the next 10 years could drop by as much as $9 million beyond the cbo's current forecast. especiallysomething, after we looked under the hood and closely examine the moving parts driving the data. we now are entering the fifth year of record low growth in national health expenditures. projection for 2013 growth is 3.8%. health care expenditures are continuing. slope wrote --
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slow growth rate. we are aware of the data trend that really hammers home the spending trend. this will be assistance. this is the second lowest level in the last 50 years. when i say prices here, i mean the payments for services, not something reflected on the charge askemaster. hospital growth which fell by more than half since 2009 2.5 1.5% is leading the way. slowly health care cost growth is captured in this chart. it shows the steady decline in medicare hospital
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spending on a per beneficiary basis. look at the far right. in 2012, there was near zero growth in hospital spending. medicare inpatient spending actually decline 2.3%. what is going on here? this is the structure, stupid. the slow economy starting with the recession does play a role. new economic research suggests the economy may have had a smaller impact on health care spending then thought as recently as one year ago. more and more are the structural changes taking
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hold in the delivery and financing of health care. what theubtedly is head of cbo meant in the quote you see here. you see he references beneficiary and provider behavior as driving the slow down. discount financial turmoil and the recession. i am sure this is no surprise to any of you. all of you know this. all of you are creating change every day in hospitals. reduce readmissions, building integrated care networks, deploying sophisticated information technology systems in expanding the use of electronic health records. it is all about efficiency and enhancing value. down should be to stay the course with the structure and innovation that is driving the slow down.
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in so doing, we will keep within reach the $900 billion in additional medicare savings that he cites. i amis why this morning sending the docs and report to the house and senate budget committee leadership. i will also send them a letter urging congress to exercise caution and avoid burdensome policy mandates and new hospital payment cuts. enough is enough. absorb 117.5t billion dollars in cuts imposed just since 2010. at the same time, the advisory commission which advises congress about medicare estimates that margins for hospitals. -8% negative a percent -- since 2014. let me conclude.
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cuts will jeopardize access to care. nd, for any further cuts will jeopardize the investment hospitals must make to accelerate the structural changes driving the new era of low-cost growth. we will move on in the program to senator wyden. we will look back to the high sign from bonnie to see whether the senator is here. he is walking in.
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he will be here in a moment. if that gives me a chance to get my notes together. our first speaker this morning is senator ron wyden, it he knew chairman of the senate finance committee. i should say the powerful senate finance committee. this has been a public servant for 32 years. he has recently taken the home senate finance committee. he was elected in 1996 and the house first in 1980.
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i have known senator wyden for much of his capitol hill career. i have always had deep admiration for him. .e has tremendous dedication he is a great leader in health care. he is committed to getting things done. to reachwillingness across the aisle to seek consensus. sometimes that causes his .emocratic colleagues anxiety he tells them they just have to live with it. what strikes me most about him is the effort he puts into policymaking. details andout the about doing whatever it takes to get good policy made by the congress. i can remember in the middle 80's when i was the republican health council on the ways and means committee sitting in my office one afternoon and i got a , on the other end was
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congressman wyden. i very rarely got calls from congressman. i do not remember ever getting a call from a congressman who was not on my committee that i served. any democraticer congressmen ever calling me in my entire career on capitol hill. it was quite striking. i did not quite know what to say. i said "yes, sir." he started into a billy was working on that he wanted to -- a bill he was working on that you wanted to make sure i understood. that was striking to me. it was unusual. unusual senator. he was an unusual congressman. he is the kind of person you really want in washington. his maiden speech before a major organization since becoming chairman of the
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senate finance committee. we are extremely grateful for him to take time from his scheduled to come down and cs here today and speak to you as morning. i want to welcome my friend, senator chairman ron wyden. [applause] >> what an inflationary introduction. a bouquetking this tossing contest, let me tell me what you know. you are so lucky to have chip. there is a reason that i called him back when i was a young congressman and i had a full head of hair and rugged good looks. he is a straight shooter. we are lucky to have him. thank you for that kind introduction. i think it would be cruel and unusual punishment to give you a big filibuster. 11 you had to rave the elements.
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-- a lot of you had to brave the elements. i thought i would offer a few thousand particularly well-chosen words. my staff wrote be speech. i can mail it to you. to give you a little bit of a sense of where i think where we are on health policy. suffice it to say most of health policy really is not health policy at all. it is essentially budget policy. ducks on the big put something that washington might be called a patch. maybe it is an extension. maybe it is called a stopgap. the big issue. it repeatedly ducks of the big
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issues. particularly a medicare when you have 10,000 people eligible for medicare every day. there is a very real costs attached with that. is to try toenge find a way to move beyond this fixation on budgeting. it would be one thing if it was sound budget policy. theften we do not get structural kinds of issues and lurch from ones budget calamity to another and come up with some sensible budget policy. we have an opportunity to begin that with the legislation that is about reimbursement for physicians. this is enormously important. manyll employed so positions.
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got an opportunity to start moving medicare in the right direction because in effect we are setting the first real date for getting serious about moving away from fee for service medicine. starting in 2017 as a result of this legislation, providers would be rewarded for pursuing that novery model longer are bill just around fee-for-service medicine. providers and other kinds of coordinated models would have an opportunity to in in when they were able to provide better quality. decide against participating can continue to pratt this. to have the going same kind of financial reward.
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quality care and advanced payment model with the potential of financial rewards are basically business as usual, status quo. we are going to say we're finally serious about setting aside a flood model. it was particularly valuable because of the challenge i envision for medicare in the days ahead. we did not have the medicare program that we have today. today medicare is all about
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chronic disease, diabetes, cancer, stroke. dominatesat really all the spending and medicare, well over 80%. is the system has not kept up with them. if you're having trouble sleeping tonight, we put a kind of detailed explanation of what the challenge is. we treated a person we call mrs. jones. chronic carepical patients. essentially after mrs. jones gets her free physical for , the whole system kind of goes off the rails on most to the time she will end up in the emergency room with the $1100 deductible. they cannot even remember all of the provider she saw on that odyssey through the health care system.
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movingt that we are now with the fdr built in a push means that and we get this past start those incentives for coordinated care we naturally can segue into a better delivery system for chronic care patients. the effortumpstart to pursue more thoughts for chronic care policies in the sgr bc snips -- c-snips, we also see improvements in those starting wetty quickly because provide that they would in in thestart locking individual care plans which is
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so important if you're going to move to a more coordinated model. the sgr bill is a big plus in terms of that real date for from fee for service. it gives us a chance for us to begin the effort to more coordinated care services for the chronic care population who are going to be what medicare is all about. part that i other am going to mention and then will follow-up with a couple of thoughts. senator razaleigh is the republican senator from iowa. make sure you get a special pat on the back to senator grassley. upis responsible for open the database.
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been includedly in the bill as well. view is when this information becomes public, that will be a new baseline for health care and services in our country. not only will it be of value in the medicare context but my sense is anybody who has an employer plan, anybody who has an hsa plan. let's say you live in denver. you look at the kind of information with respect to billing and services and quality that this legislation is going to make more transparent, if you have an employer plan you are going to say why can't i have that same rate in those kind of benefits you have to medicare? this will be a big plus for the entire health care system.
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been included in sgr as well. let me wrap up with a comment on the aca. we are going to be looking at it in the senate finance committee. my general approach to this is going to be much like my approach to when i voted for george w. bush tossed medicare program. democrats whoine voted in favor of that. whelps, that to show for it. they were a lot of friends and days when i worked with seniors who said that is it. we are not going to support you anymore. we do not want you to do all this bipartisan stuff. that program is a giveaway to big pharma, it george w. bush should not have voted for it.
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i cannot recall an occasion where i got more flak than when i voted for this. as you know, it has turned out to be an extraordinary success story. the last figures indicated it has come in 45% below projected cost. there really is not anybody in the congress who now talks about appeal or derailing it or something of that nature. an enormous number of seniors have peace of mind and security as a result of making that work. ofring this up only by way saying that a lot of the stories 's few monthshe aca show a remarkable resemblance to the stories about part d in its few months. western civilization is going to end. the bureaucracy is torturing us.
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ist i'm going to try to do bring the same bipartisan approach as i did in terms of working with a republican president got his major health initiative through. i'm going to bring that same approach should try to work with colleagues in a bipartisan way in the aca. let me use that as a kind of opening. softball questions are especially welcome. they for the work you do. you pay -- play a pivotal role in the health care delivery system. i enjoyed working with you in the past. we have a lot to do in the days ahead. i look or to continuing the relationship. thank you for this morning. [applause] all right. may want to
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moderate this. i see some questions. do we have microphones out there? >> the question i have for you ruralre are two key medicare extenders. it is critical to roll hospitals. -- to rule hospitals. they were put in as a permanent extension. i would like to get your ideas on how you think this is going to play out in the next couple of with the debate with the house. i am obviously supportive of those coming from a state like oregon that depend on them. is a procedural path on the sgr bill. i do parachuting in at the last moment. the discussions were largely conducted by chairman baucus.
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the basic lay of the land has been established. having said that on the procedural aspect, we are still at the heavy lifting department pay for it. the i am sure providers are automatically saying where are we going to go for the pay force . if i have my way, we would tackle some of these military runs and boom areas and systems i am a newly minted one. this.right after
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i am going to have to have discussions with the house. i have been supportive of those programs. i will continue to be. we will have to make some calls on a cost-effective way to pay for it. >> that was a real softball. hospitals have been used with we have about $117 billion in cuts since 2010. these have a real impact on the service we provide and jobs as well. what is your view on having hospitals paying for other programs? >> what is striking about it is it used to be providers had to face tough decisions in terms of taking cuts that were used for
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health care. people would swallow hard and say maybe if we take a hit a goes to benefit the overall help system and at some point that would wash up in our shores. onset -- beyond it and health care cuts essentially have been targeted for entire other areas of the budget. i am not holding any rallies for that particular approach. nt used to be they shared a area and magically produce pay force.
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they would literally do that. they raise all the money. spend itman gets to all. the days are over. that is not the way budgeting is done anymore. there are tough calls. part of what happens when you caught -- cannot make a permanent policy change, which is what i want, a permanent fix another,r, from one to it doesn't provide the predictability and certainty that is needed in the health care system, particularly if you try to move away from fee for .ervice medicines i very much want to address this permanently.
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it does mean we're going to have some tough touch it calls. i am going to do everything i can specifically apropos of your point to make sure at least health care reductions in spending are not used to bail out some other part of the budget. fascinating to see the role of the budget once more in all of this. >> thank you for being here. i wanted to take a second. it would cheer that the tax reform bill is not going to move anywhere this year. you have always had great bipartisan ideas. i'm wondering if you could talk about prospects after the election. >> here is my sense of where we are. chairman camp is a good guy. he is trying to build on some of the ideas that i am supportive the 1980's.s in a big group of democrats worked
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with ronald way in -- ronald reagan. they held down the rate uninsured progressivity. he has long been a supporter of that. challenge isthe going to be is look at where the house has been in terms of its and make at least some progress in terms of building toward tax reform. what happened last november, and it was widely publicized in a lot of discussion about it, was the house leadership essentially said that obamacare was going to be there for 2014. that is what they were going to put the focus on. that reallyd that, change the timetable. stillan baucus was chairman of the senate finance committee. he was retiring in 2014.
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i had to make some decisions really about where we ought to go. starting to think even when he was chair how this would affect tax reform. if the houseme republican leadership was going to change the timetable in that way, we had to figure out what to make as much progress on tax reform as we could, recognizing the judgment last november. the house in the senate have to deal with something called the tax extenders. these are about 55 provisions, a number of which affect here. it will be possible as we deal with the extenders. it use them as a springboard for broader reform. it involves energy. two of them would be enough to
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obtain your object is. they generate some savings. there are at least three major pieces of legislation that have a date stamped on them. you asked about tax reform. we introduce the first reformsan and contacts back in 2011. he is a republican from new hampshire. i still consider that. a date stamp have
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on them. they have already expired. shortly, we are going to run out of a highway trust fund. cannot get to a hospital and health care services with little league transportation systems. my hope is to use these bills as a springboard to broader reform. we can particularly permanently deal with the sgr. we can use this as a springboard to the broader reforms and chronic care. if we can make this policy with --pect to its sinister
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senator. the next four or five months it is a really important time. there are real needs that have to be met. obviously you are concerned that will beget made, particularly pay fors. my pledges to work with you on these kinds of issues to try to come up with sensible bipartisan policy over the next 45 months months to make sure we see those decisions through the kind of prism that what we are going to do is going to make sense and use it as a springboard for the broader reform. to be continued. thank you. [applause]
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>> senator wade will -- roy blunt is from missouri. he has served in the leadership positions for most of his time in congress on that which is unusual. he is currently the vice chair of the senate republican caucus,
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the number five accident leadership spot. member of the appropriations committee. he has an extensive career in public service. he was elected to the senate in 2010. charting in 1996, he was elected for seven terms as a member of the house of representatives. elected him three times to serve as the house majority whip and the republican whip, the second-highest republican in the house. senator blunt is familiar with how policy and hospital policy. he is one of several standingatives who are with hospitals and challenging proposals that would reduce vital medicare backstop payments which some would like to cut. i have no the senators since he was in the house.
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to me he represents someone who get things done but understand it takes developing relationships to get inks done. i am not sure i have everything to tim for this other than that date -- things done. i am not sure i have ever for this other than that day. he was kind enough to come down to the going away party that my colleagues and the board were having that day. it just really took me aback that he was gracious enough to come downtown and to say goodbye to someone who is leaving a job. it struck me. kind ofcts an unusual person and a real understanding of the importance of developing relationships. appreciate him. i know you will appreciate him. let me introduce senator roy
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blunt of missouri. [applause] thank you. thank you for letting me come this morning. thank you for that generous introduction. gonew you were going to other places. we need a lot of understanding how this meet the real-world circumstances rather than what we think the circumstances might be. wyden,say about senator he is going to be a great chairman of the finance committee. i am on the other side of the aisle. i hope that maybe a year from now he is actually the ranking democrat. whether he is the chairman or is ang democrat, ron wyden person who reaches out. he is a person who is willing to
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take a bit of a chance to make something happen that otherwise would not happen. one of the problems in washington today is that clearly i do notpeople hold if get 100% i would assume not get anything. it is almost a certain formula not to get anything. we see that happen day after day after day. surely the -- country is getting as tired of it as i am. by the well represented entire team with the federation of american hospitals here. i am glad you are here today. we need advice on these issues. the affordable care act proves the law of unintended consequences. that theconsequences country and every industry should have been more aware of.
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i said on the floor the other day as i look over the nine things that i either sponsored or cosponsored in 2009 that i thought would have taken the best health care system in the world and opened it up a little more fully. i said it is too bad we do not just have this debate today. i was a member of the house in 2009. one of my assignments at the time was to come up with our alternatives. at some point i said we could claim some victory if by the time we were done every member of the house knew the difference in medicare and medicaid. [laughter] i am pretty sure right now every member of the house and the senate does know the difference in medicare and medicaid. casewas not the necessarily when we entered into this debate. you would be better acted, the , the country it would be more insistent that we do this the right way.
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surely we would not try to manage everybody's health-care andrage in a new way restructure 16 or 17% of the economy. whether we can get back to that or not, i do not know. i know it would be a better debate if we did. i know some sort of incremental implementation would have been a better ink. i introduced the bill in the peoplehat kept 3 million on their interest a little bit longer people -- a little bit longer. some say these are people who do not want to pay for insurance. every state lets them stay on so they are 21. some states let them stay until they are 23. i introduced a bill that would have gone to 25. the demonstration put it in the to make it 26
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incident 25. it created an easy way to move them from the uninsured column column.nsured a fourth of august people that got health care that did not have it before the passage of this will were people -- bill were people now on their parents insurance. i wanted to see the bill we introduce. it was three and a third pages. introduced 13.ve they were very simple. very straightforward. it probably didn't sure 3 million people who were not insured before. 3 million people who were not insured before. what about the others? the law of unintended consequences is having a big impact now. i met with some of our executives in missouri a few days ago. they said their fastest-growing
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unpaid debt group is now among the insured with high deductibles. deductibles so high that many insured cannot pay the deductible. that sliver of health care is a problem. deductibles are generally higher than the have been before. . the deductible had to go up. often the premium went up as well. these are critical issues we have to deal with. i want to talk a little bit that the medicare issues need to be dealt with and what we can do to deal with them. concerned as were 39 of my colleagues. 19 democrats and 20 other republicans signed a letter to before thent and cmh
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medicare advantage cuts were announced or as they were being announced. he said do not cut this program anymore. peoplemake it harder for to supplement their insurance. do not make it harder for people in a noncompetitive market place to have a competitor that allows them to pay that part of the bill. what will happen is you reduce medicare advantage. see prescription increases. a lot of seniors are not going to have this covers that they have had before. marketplace is a place where the government can do some good. this was the first program in health care that the government ever got involved in. not to operate a
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system but to create a marketplace. to see that happen and see the early result until recent changes. i do not know what the changes will mean. this came in year after year at than thercent lower lowest possible estimate of cost when the bill was passed. the marketplace can and does work. medicare bad debt is another area where if we ink it has no impact on hospitals and health care providers we are making a big mistake. atneed to can need to look medicare. it should not become a pay for. i think we need to be very thoughtful that we understand medicare bad debt is a critical program for hospitals that are already operating on narrow margins. to make theed
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margin so narrow that hospitals cannot stay in existence. it leads me to another group of hospitals.rural it extends medicare dependent hospitals and low-volume of this through the end fiscal year. we need to be very thoughtful if we think we're going to move into a genetically different environment next year i was pleased to be the principal sponsor of the medicare audit improvement act. sometimes this is called the rack. from the middle ages until about the 1700s, the rack was widely used. the purpose was to stretch you until you finally admitted whatever had to be admitted so they stopped stretching the rack. it seems to me there's an awful lot of that principle in the recovery audit program. where the recovery audit program
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, particularly for small ton't know how fight back. even if they do, the fight takes so long that it would appear to me that over and over again on the role of the federal government is to get you to give is a very aggressive stand early in the discussion -- we have more time, more lawyers and more money than w you do. you want to settle or continue to fight? we need to look at this and be sure that -- nobody bets taxpayer money to wasted. nobody wants it to be spent in a fraudulent way. but there has to be a better way than the way we are pursuing now to see that does not happen.
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the bills that we have that they would help rural hospitals are important and we need to pay attention to them. another issue that you will have are.d on is bsg .- the sgr we need to permanently fix this. i was a freshman in the house of representatives when the legislation passed that created this annual cutting of compensation. i voted against it. i don't know how many there were. not very many. i have said many times, it may have been the best book i ever cast area did i said come it looks like we're doing two things here. we are making any mistake a crime. surely that can't be what the government wants to do. and then we are creating this big pay for that will never be used. it really never has been used. i think one time in a decade, the sgr was allowed to go into
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force. what it has done is take a lot of energy every year from health-care providers, doctors and others who had to come to washington and do everything that their say compensation is no longer than that was the year before. this can't be a good way to pursue this for lots of reasons. has come up with a lower fix this.permanently we should take advantage of that lowered number. phony pay for. surely there were people who could have figured out when this bill was on the floor that we would not be cutting compensation every year. what were we going to be doing ? use this as an excuse to have
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health care providers come back and say, what else can you give us? that can be the best way to move forward. it's time to stop kicking that can down the road and do as much as we can. wyden will look at that carefully. whether we can get this done this year or not, i don't know. we should have gotten it done closer to the beginning of this process and right now because it's just created an annual embarrassment where health care providers have to take time every year to come and say, here is why we need to be paid at least as much as we were paid five years ago and then six years ago and then seven years ago. now we are where we are. i would also like to talk a little bit about medical liability reform. on the list of things i introduced in 2009 when there there was view that
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no other alternative out there. there were plenty of alternatives out there. there was no other 2600 page bill. there were things like liability reform, creating a marketplace by buying across state lines, more transparency by health care , the ability to expand high-risk pools -- i get contacts every day from missourians, the 4000 people who were on the high-risk pool when it went out of existence. virtually none of them have insurance that is substantially higher than it was. if you're in the high-risk pool, you are paying 135% of the normal premium. you did have a pre-existing condition. 135% of the normal premium was
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what you are paying then. virtually everyone pays more than that now. expanding the high-risk pool him and funding that in a more substantial way would have been one of the ways to create an answer to the problem, what happens if i don't have insurance and i have a pre-existing condition? nobody wants anybody to be in that trap but there was a better way to do this. i think of the 10 bill scientist, the biggest one was 75 pages long. they would've all had a positive impact on the system. -- of all the 10 bills i introduced. administration, it is something that does not get talked about as much as it should. you understand the driving impact of the liability system better than any group i could probably talk to besides doctors themselves. we need to do something about that. i introduced legislation that in
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the last congress and this congress that has companion legislation that would essentially restructure liability reform. i introduced legislation where if people come to the emergency room without insurance, you have the same liability exposure that people have been federally qualified clinics. which is no liability exposure for most cases. if people come in and you don't have insurance, you are required the samethem with liability exposure in federally qualified clinics that expand to the emergency room as all. be and willtury can time fordly changing health care unless we don't embrace all the things that could happen. i think we will look back at health care a decade from now and realize, during our infante, what a truly
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science it was. from smart phones to 3-d health care impact in ways that are not anticipated yet. we need to be sure the federal government is involved in that so it protects consumers but not so involved that it slows down the innovations that can happen. between all the technology that and increased doubling nihugh funding and other research and make a tremendous difference in how we deal with people's health care challenges, how we prevent those challenges from becoming as big as they might otherwise do to make this a great decade and a great future for health care and for those who provide health care. at the front of all that
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argument, we will see hospitals and the changing role of hospitals. i look forward to being part of changes and role being part of the immediate challenges by trying to make sure we start some new program and don't make it impossible to provide quality health care that american hospitals have been providing and will continue to provide. the key for letting me come this morning. [applause] things you'll. all for letting me come this morning. at 12:40 p.m., we will have live coverage of this year's final day of the conservative political action conference. with former house speaker newt gingrich, conservative columnist ann coulter and former alaska governor sarah palin. you can watch them all live, beginning at 12:40 p.m. on

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